I can probably add a small piece to the puzzle. I have never worked for the VA, but my dental implant rep was telling me about how wasteful it is a few years back. When placing implants you use a set of surgical carbide burs and other instruments which do have a finite lifespan depending upon the nature of the bone being prepared with them, proper handling, etc. Most of the burs or other cutting tools require replacement after a maximum of 20 implants, but probably more realistically 10-15. The surgical kit is expensive and yes, we clean the instruments by hand, then ultrasonic, the steam autoclave, and reuse them. Our autoclave passes regular tests, I think it's every 2 weeks, with a lab report. It's totally safe, when done right and normal practice. The implant surgical kit is relatively expensive. I am sure the VA gets a discount, but they are $1000-1500 my cost. Divide that by 15 uses and that is a manageable cost.
BUT, my implant rep was telling me that at the VA.... ANYTHING used in a surgery is disposed of. Their policy prevents any of the burs being reused on another patient. SO, for one implant you have the cost of the implant to the VA, which is probably $200-400 and then the surgical kit too. I am not fully certain what instruments this covers, but many surgical instruments are made to last 10 years or more. I don't know if they are buying lower quality and trashing them, but that would still be very expensive. I would guess they are using mirrors, retractors, etc all disposable, which is doable, but also wasteful and costly. Maybe the dentist was reusing a surgical instrument like the ones I am describing, (which is a normal practice and safe when done properly, just not VA policy?)
I guess the policy was put forth to 0% chance of cross contamination between patients, but the cost is outrageous. I get the why of the policy, but the how is pretty wasteful. I think what it really comes down to though is the VA setting. In my office, it is mine, and I take pride in what I am doing, while also employing staff who not only know how to keep patients safe, but know that it is our moral and legal obligation to do so.... and that are proud of our standards and practices. I suspect, just suspect, that it is more difficult to foster that sort of environment in a larger "clinic" setting with possibly less engaged, but larger numbers of employees and staff. (My point being they try to eliminate error, by simply disposing instead.)
I really hope it was not a case of improperly "cleaning" instruments, like just spraying them a little and wiping them down. I usually think that there is some sort of psychiatric issue involved with clinicians who do things like that. It just doesn't make sense.
BUT, my implant rep was telling me that at the VA.... ANYTHING used in a surgery is disposed of. Their policy prevents any of the burs being reused on another patient. SO, for one implant you have the cost of the implant to the VA, which is probably $200-400 and then the surgical kit too. I am not fully certain what instruments this covers, but many surgical instruments are made to last 10 years or more. I don't know if they are buying lower quality and trashing them, but that would still be very expensive. I would guess they are using mirrors, retractors, etc all disposable, which is doable, but also wasteful and costly. Maybe the dentist was reusing a surgical instrument like the ones I am describing, (which is a normal practice and safe when done properly, just not VA policy?)
I guess the policy was put forth to 0% chance of cross contamination between patients, but the cost is outrageous. I get the why of the policy, but the how is pretty wasteful. I think what it really comes down to though is the VA setting. In my office, it is mine, and I take pride in what I am doing, while also employing staff who not only know how to keep patients safe, but know that it is our moral and legal obligation to do so.... and that are proud of our standards and practices. I suspect, just suspect, that it is more difficult to foster that sort of environment in a larger "clinic" setting with possibly less engaged, but larger numbers of employees and staff. (My point being they try to eliminate error, by simply disposing instead.)
I really hope it was not a case of improperly "cleaning" instruments, like just spraying them a little and wiping them down. I usually think that there is some sort of psychiatric issue involved with clinicians who do things like that. It just doesn't make sense.
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so i dont cry. They couldnt kill us the first time so they try with their hospitals
